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Venturi mask adjuvant oxygen therapy in severe acute ischemic stroke
Elley H H Chiu1, Chin-San Liu, Teng-Yeow Tan
1Division of Acupuncture, Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, 123 Tapei Road, Niao Sung Hsiang, Kaohsiung County 833, Taiwan.
Background:
The effect of oxygen therapy in acute ischemic stroke remains undetermined.
Objective:
To investigate the feasibility of eubaric hyperoxia therapy by Venturi mask (VM) in a group of patients who experienced a severe acute ischemic stroke.
Design:
Patients experiencing a first-ever large middle cerebral artery infarction were recruited within 48 hours after stroke. Patients were subdivided to undergo therapy with a VM with a fraction of inspired oxygen of 40% or with a nasal cannula. A large middle cerebral artery infarction was defined as a large low-attenuation area of more than one third of the middle cerebral artery territory on brain images. Stroke severity was evaluated by the National Institutes of Health Stroke Scale.
Results:
Seventeen patients were enrolled in the VM group and 29 in the nasal cannula group. All the demographic and clinical characteristics were equally distributed initially. The mean initial National Institutes of Health Stroke Scale score was 20.5 and 18.9 in the VM and nasal cannula groups, respectively. Atrial fibrillation was found in 11 (65%) patients in the VM and 17 (59%) patients in the nasal cannula groups. The VM therapy was initiated within 13.7 (range, 3.0-41.5) hours after stroke and the duration was 132.9 (range, 48.0-168.5) hours. In-hospital mortality was 1 (6%) in the VM group and 7 (24%) in the nasal cannula group (P=.12). In the VM group, there were fewer incidences of fever (4 [24%] vs 15 [52%]; P=.06), pneumonia (1 [6%] vs 6 [21%]; P=.18), and respiratory failure (3 [18%] vs 8 [28%]; P=.45), but a higher incidence of bedsores (3 [18%] vs 2 [7%]; P=.29).
Conclusions:
By using VM therapy with a fraction of inspired oxygen of 40%, there might be less mortality and comorbidities in treated patients who experienced a severe acute ischemic stroke. Further randomized confirmatory studies should explore the decreased mortality in patients who experience a severe acute ischemic stroke, especially in those with a large middle cerebral artery infarction who undergo VM therapy with a fraction of inspired oxygen of 40%.
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